EXIT: ex-utero intrapartum treatment. A case report and literature review
DOI:
https://doi.org/10.18597/rcog.193Keywords:
Ex-utero intrapartum treatment (EXIT), congenital cervical mass, congenital high airway obstruction syndrome (CHAOS)Abstract
Introduction and objective: The EXIT procedure (ex-utero intrapartum treatment) is aimed at securing the fetal high airway whilst maintaining integral uteroplacentary circulation. The purpose of reporting this case was to describe the procedure and review the worldwide literature regarding anesthetic considerations and associated complications.
Materials and methods: The case of a 39-week gestation female neonate is presented; she was born at the Clínica del Country (a private highlevel healthcare general hospital located in Bogota, Colombia) by the ex-utero intrapartum treatment (EXIT) technique due to a potential obstruction of the airway detected during third-trimester echography. A systematic search was made of Medline databases via PubMed, Ovid, and the SciELO Latin-American database using the following key words: EXIT, ex-utero intrapartum treatment, congenital cervical mass, CHAOS.
Results: 183 articles were found, of which 76 were directly related to the topic; 8 case reports, 2 case series and 14 reviews of the topic were selected.
Conclusion: The EXIT strategy has proved to be a useful tool in the suitable management of neonates suffering congenital obstruction of the airway.
Author Biographies
Juan Camilo Ospina-García
Carolina Wuesthoff-Prieto
Santiago Eslava-León
References
Morris LM, Lim FY, Crombleholme TM et al. Ex Utero Intrapartum Treatment Procedure: A Peripartum Management Strategy In Particularly Challenging Cases. J Pediatr 2009;154:126-31.e3.
Chiu HH, Hsu WC, Shih JC, Tsao PN, Hsieh WS, Chou HC. The Exit (Ex Utero Intrapartum Treatment) Procedure. J Formos Med Assoc 2008;107:745-8.
Skarsgard ED, Chitkara U, Krane EJ, Riley ET, Halamek LP, Dedo HH. The OOPS Procedure (Operation on Placental Support): In utero airway management of the fetus with prenatally diagnosed tracheal obstruction. J Pediatr Surg 1996;31:826-8.
MacKenzie TC, Crombleholme TM, Flake AW. The ex-utero intrapartum treatment. Curr Opin Pediatr 2002;14:453-8.
Mychaliska GB, Bealer JF, Graf JL, Rosen MA, Adzick NS, Harrison MR. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg 1997;32:227-30.
Ferrer L, Paredes P. Manejo anestésico de paciente obstétrica sometida a EXIT. Rev Colomb Anestesiol 2008;36:297-9.
Liechty KW. Ex-utero intrapartum therapy. Semin Fetal Neonatal Med. 2010;15:34-9.
Hirose S, Harrison MR. The ex utero intrapartum treatment (EXIT) procedure. Semin Neonatol 2003;8:207-14.
Marwan A, Crombleholme TM. The EXIT procedure: principles, pitfalls, and progress. Semin Pediatr Surg 2006;15:107-15.
Fink RJ, Allen TK, Habib AS. Remifentanil for fetal immobilization and analgesia during the ex utero intrapartum treatment procedure under combined spinal–epidural anaesthesia. Br J Anaesth 2011;106:851-5.
Kudo T, Kimura F, Hashimoto H, Wada M, Hirota K. Anesthetic management for EXIT (ex-utero intrapartum treatment) of a twin gestation: one normal and one with a large epignathus. Masui 2012;61:307-10.
Lee H, Ryu JW, Kim DY, Lee GY. Anesthetic management of the ex utero intrapartum treatment (EXIT) procedure. Korean J Anesthesiol 2010;59:S154-S7.
Schwartz DA, Moriarty KP, Tashjian DB, Wool RS, Parker RK, Markenson GR, et al. Anesthetic Management of the EXIT (Ex Utero Intrapartum Treatment) Procedure. J Clin Anesth 2001;13:387-91.
Ioscovich A, Shen O, Sichel J-Y, Lajos Y, Orkin D, Bromiker R, et al. Remifentanil-nitroglycerin combination as an anesthetic support for ex utero intrapartum treatment (EXIT) procedure. J Clin Anesth 2011;23:142-4.
Olutoye OO, Olutoye O. EXIT procedure for fetal neck masses. Curr Opin Pediatr 2012;24:386-93.
Walker P, Cassey J, O’Callaghan S. Management of antenatally detected fetal airway obstruction. Int J Pediatr Otorhinolaryngol 2005;69:805-9.
Laje P, Johnson MP, Howell LJ, Bebbington MW, Hedrick HL, Flake AW, et al. Ex utero intrapartum treatment in the management of giant cervical teratomas. Journal of Pediatric Surgery 2012;47:1208-16.
Garcia P, Olutoye OO, Ivey RT, Olutoye OA. Case Scenario: Anesthesia for Maternal-Fetal Surgery. The Ex Utero Intrapartum Therapy (EXIT) Procedure. Anesthesiology 2011;114:1446-52.
Woodard TD, Yong S, Hotaling AJ. The Ex Utero Intrapartum Treatment (EXIT) procedure used for airway control in a newborn with cervical fetus in fetu: A rare case. Int J Pediatr Otorhinolaryngol 2006;70:1989-94.
Zadra N, Giusti F, Midrio P. Ex utero intrapartum surgery (EXIT): indications and anaesthetic management. Best Pract Res Clin Anaesthesiol 2004;18:259-71.
Cauldwell CB. Anesthesia for fetal surgery. Anesthesiol Clin North America. 2002;20:211-26.
Lazar DA, Olutoye OO, Moise KJ, Ivey RJ, Johnson A, Ayres N, et al. Ex-utero intrapartum treatment procedure for giant neck masses-fetal and maternal outcomes. J Pediatr Surg 2011;46:817-22.
Choleva AJ. Anesthetic management of a patient undergoing an ex utero intrapartum treatment (EXIT) procedure: a case report. AANA J 2011;79:497-503.
How to Cite
Downloads
Downloads
Published
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
